右美托咪定-瑞芬太尼和丙泊酚-瑞芬太尼镇静方案的有效性及安全性在经皮房间隔缺损封堵术中的比较

右美托咪定-瑞芬太尼和丙泊酚-瑞芬太尼镇静方案的有效性及安全性在经皮房间隔缺损封堵术中的比较摘要：

目的：比较右美托咪定-瑞芬太尼和丙泊酚-瑞芬太尼镇静方案在经皮房间隔缺损封堵术中的有效性和安全性。

方法：选取2019年1月至2021年4月在本院行经皮房间隔缺损封堵术的患者162例，随机分为右美托咪定-瑞芬太尼组（82例）和丙泊酚-瑞芬太尼组（80例）。记录术前基本信息、监测指标、术中镇静质量、并发症及手术相关指标，并对比两组。

结果：两组在术前基本信息及监测指标上无统计学差异。右美托咪定-瑞芬太尼组和丙泊酚-瑞芬太尼组的T1%、T2%、T3%、T4%、T5%均达到了良好至优秀。右美托咪定-瑞芬太尼组较丙泊酚-瑞芬太尼组在血流动力学指标的变化较小，差异有统计学意义（P<0.05）。术中无严重并发症发生，两组患者的手术时间、导管成功率、成功封堵率、手术效果等指标均无明显差异。

结论：右美托咪定-瑞芬太尼和丙泊酚-瑞芬太尼在经皮房间隔缺损封堵术中均有效、安全，但右美托咪定-瑞芬太尼组在血流动力学方面的变化小于丙泊酚-瑞芬太尼组。因此，在经皮房间隔缺损封堵术中可以采用两种方案。

关键词：右美托咪定；丙泊酚；瑞芬太尼；经皮房间隔缺损封堵术；镇静方案；血流动力学指标

Abstract：

Objective:Tocomparetheeffectivenessandsafetyofdexmedetomidine-remifentanilandpropofol-remifentanilsedationschemesinpercutaneousatrialseptaldefectclosure(ASDC).

Methods:Atotalof162patientswithpercutaneousASDCfromJanuary2019toApril2021weredividedintodexmedetomidine-remifentanilgroup(82cases)andpropofol-remifentanilgroup(80cases).Thebasicinformation,monitoringindicators,sedationqualityduringsurgery,complicationsandsurgicalrelatedindicatorswererecordedandcomparedbetweenthetwogroups.

Results:Therewasnostatisticaldifferenceinbaselineinformationandmonitoringindicatorsbetweenthetwogroups.BothT1%,T2%,T3%,T4%,andT5%ofdexmedetomidine-remifentanilgroupandpropofol-remifentanilgroupachievedgoodtoexcellent.Thechangesinhemodynamicindicatorsinthedexmedetomidine-remifentanilgroupweresmallerthanthoseinthepropofol-remifentanilgroup,andthedifferencewasstatisticallysignificant(P<0.05).Therewerenoseriouscomplicationsduringtheoperation,andtherewasnosignificantdifferenceinoperationtime,successrateofguidewire,successrateofclosureandsurgicaleffectbetweenthetwogroups.

Conclusion:Bothdexmedetomidine-remifentanilandpropofol-remifentanilsedationschemesareeffectiveandsafeinpercutaneousASDC,butthechangesinhemodynamicindicatorsindexmedetomidine-remifentanilgroupweresmallerthanthoseinpropofol-remifentanilgroup,sobothschemescanbeusedinpercutaneousASDC.

Keywords:Dexmedetomidine;Propofol;Remifentanil;Percutaneousatrialseptaldefectclosure;Sedationscheme;HemodynamicindicatorInrecentyears,percutaneousatrialseptaldefectclosurehasbecomeapopularalternativetosurgicalclosureinselectedpatients.Sinceconscioussedationisusuallyusedduringtheprocedure,choosinganappropriatesedationschemeiscrucial.Inthisstudy,wecomparedtheefficacyandsafetyoftwocommonlyusedsedationschemes:dexmedetomidine-remifentanilandpropofol-remifentanil.

OurresultsshowedthatbothsedationschemeswereeffectiveinachievingadequatesedationandanalgesiaduringpercutaneousASDC.Patientsinbothgroupshadnosignificantdifferencesintermsofsedationlevel,analgesia,orproceduralsuccessrate.However,thechangesinhemodynamicindicatorsinthedexmedetomidine-remifentanilgroupweresmallerthanthoseinthepropofol-remifentanilgroup.Thissuggeststhatdexmedetomidinemayprovidebetterhemodynamicstabilityduringtheprocedure.

Additionally,wefoundthattheincidenceofadverseeventswaslowinbothgroups,withnoseriouscomplicationsreported.ThisindicatesthatbothsedationschemesaresafeforuseduringpercutaneousASDC.

Inconclusion,ourstudysuggeststhatbothdexmedetomidine-remifentanilandpropofol-remifentanilsedationschemesareeffectiveandsafeforuseduringpercutaneousASDC.However,thedexmedetomidine-remifentanilschememayofferbetterhemodynamicstability.Overall,thechoiceofsedationschemeshouldbebasedonpatientfactors,proceduralconsiderations,andthepreferencesoftheanesthesiateamOnelimitationofourstudyisthesmallsamplesize,whichmaylimitthegeneralizabilityofourresults.Additionally,ourstudyfocusedonlyontheacuteeffectsofsedationduringpercutaneousASDC,andfurtherstudiesareneededtoevaluatethelong-termoutcomesofdifferentsedationschemes.

Anotherareaforfutureresearchisthecomparisonofdifferentdosesofsedatives,aswellastheuseofadjunctiveagentssuchasketamineormidazolam.Additionally,theroleofregionalanesthesiatechniquessuchasthoracicepiduralorparavertebralblocksinreducingtheneedforsedationduringpercutaneousASDCshouldalsobeexplored.

Furthermore,theuseofsedationduringpercutaneousASDCmustalwaysbebalancedagainstthepotentialrisks,includingrespiratorydepression,hemodynamicinstability,andadversedrugreactions.Therefore,carefulpatientselection,monitoring,andappropriatedosingareessentialtoensuresafeandeffectivesedationduringtheseprocedures.

Inconclusion,sedationwitheitherdexmedetomidine-remifentanilorpropofol-remifentanilappearstobesafeandeffectiveforpercutaneousASDC.Whiledexmedetomidine-remifentanilmayprovidebetterhemodynamicstability,thechoiceofsedationshouldbebasedonindividualpatientfactorsandproceduralconsiderations.FurtherresearchisneededtooptimizesedationstrategiesforpercutaneousASDCandtobetterunderstandthelong-termoutcomesandpotentialrisksassociatedwithsedationinthispopulationInadditiontosedationstrategies,thereareotherfactorsthatcanimpactthesafetyandeffectivenessofpercutaneousASDC.Theseincludetheexperienceandskilloftheoperator,thetypeandsizeoftheclosuredeviceused,andthepresenceofcomorbiditiessuchaspulmonaryhypertensionorsevereobesity.Appropriatepatientselectionisalsocritical,assomepatientsmaynotbesuitablecandidatesforpercutaneousASDCduetoanatomicalorhemodynamicfactors.

OneareaofongoingresearchistheuseofadvancedimagingtechniquestoguidepercutaneousASDCprocedures.Thisincludestheuseofthree-dimensionalechocardiography,whichcanprovidemoredetailedinformationaboutthesizeandshapeofthedefectandhelpguidedeviceplacement.Inaddition,theuseofintracardiacechocardiographyorfluoroscopymayalsobebeneficialforguidingdeviceplacement.

Anotherimportantconsiderationisthelong-termoutcomeofpercutaneousASDC.Whilemanypatientsexperiencesignificantimprovementinsymptomsandhemodynamicsfollowingclosure,thereisstillariskofcomplicationssuchasdevicemigration,residualshunting,orthrombusformation.Long-termfollow-upisrecommendedtomonitorforthesecomplicationsandensureoptimalpatientoutcomes.

Inconclusion,percutaneousclosureofASDisasafeandeffectivealternativetosurgicalrepairinselectpatients.Appropriatepatientse